Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

Ayuzawa, Nobuhiro; Ishibashi, Yoshitaka; Takazawa, Yutaka; Kume, Haruki; Fujita, Toshiro

doi:10.3747/pdi.2010.00234

Cited by 49 publications

(40 citation statements)

References 39 publications

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“…Unlike PD duration, the type of PD solutions received exerted no significant effect on the trend of dialysate MMP-2 or TIMP-1 concentrations. This was an unexpected outcome because the use of biocompatible solutions has been associated with an improvement in peritoneal membrane morphology (22). Similarly, an observational study reported a significant decrease in both PD effluent MMP-2 levels (141.4 ± 52.5 to 91.3 ± 15.1 ng/mL; p < 0.05) and PSTR (D:P Cr4h 0.72 ± 0.09 to 0.60 ± 0.06; p < 0.03) in prevalent PD patients (mean PD duration 44.6 months) when their treatments were switched from standard solutions to biocompatible solutions (14).…”

Section: Discussionmentioning

confidence: 99%

Higher Dialysate Matrix Metalloproteinase-2 Levels are Associated with Peritoneal Membrane Dysfunction

et al. 2016

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♦ Background: Peritoneal dialysis (PD) patients develop progressive and cumulative peritoneal injury with longer time spent on PD. The present study aimed to a) describe the trend of peritoneal injury biomarkers, matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-1 (TIMP-1), in incident PD patients, b) to explore the capacity of dialysate MMP-2 to predict peritoneal solute transport rate (PSTR) and peritonitis, and c) to evaluate the influence of neutral pH, low glucose degradation product (GDP) PD solution on these outcomes. ♦ Methods: The study included 178 participants from the balANZ trial who had at least 1 stored dialysate sample. Changes in PSTR and peritonitis were primary outcome measures, and the utility of MMP-2 in predicting these outcomes was analyzed using multilevel linear regression and multilevel Poisson regression, respectively. KEY WORDS: Biocompatible; glucose degradation products; matrix metalloproteinase-2; peritoneal dialysis; peritoneal solute transport rate; peritonitis; tissue inhibitor of metalloproteinase-1.

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Section: Discussionmentioning

confidence: 99%

Higher Dialysate Matrix Metalloproteinase-2 Levels are Associated with Peritoneal Membrane Dysfunction

et al. 2016

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“…However, this phenomenon was not observed in the present cohort that was treated with neutral-pH solution. Recent studies suggest that the use of neutral solutions is associated with improved mesothelial layer integrity, decreased thickening of the submesothelial compact zone, and less vasculopathy when compared with those that occur in response to conventional acid solutions (31)(32)(33). These observations suggest that this newer solution might help attenuate the risk of EPS.…”

Section: Discussionmentioning

confidence: 99%

Encapsulating Peritoneal Sclerosis in the Era of a Multi-Disciplinary Approach Based on Biocompatible Solutions: The Next-Pd Study

Miyazaki²,

et al. 2014

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♦ Introduction: Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD). Over the past decade in Japan, a multidisciplinary approach has been adopted to minimize the incidence and improve outcomes of EPS. This strategy includes planned PD discontinuation for high-risk patients and the introduction of biocompatible solutions. This study examined the current clinical status of EPS in representative PD centers in Japan. ♦ Design, setting, participants and measurements: Patients (n = 1,338) from 55 PD centers in Japan who were using neutral-pH solutions from the initiation of therapy (mean age, 62 years; median PD duration, 32 months; concomitant use of icodextrin, 35.2%; PD and hemodialysis combination therapy, 12.2%) were assessed every 6 months to ascertain the reasons for PD discontinuation and the development of EPS development. Outcomes were also recorded. The study period was from November 2008 to March 2012. ♦ Results: There were 727 patients who discontinued PD, including 163 deaths. Among all causes of PD withdrawal except for death, planned PD discontinuation to avoid EPS was utilized in 58 cases (7.1% in total). The strategy was increasingly utilized in proportion to the duration of PD: 0.5% for patients undergoing PD for < 3 years, 0.6% for patients undergoing PD for 5 years, 14.7% for patients undergoing PD for 8 years, and 35.5% for patients undergoing PD for > 8 years. Fourteen patients developed EPS (three cases after PD), which corresponded with an overall incidence of 1.0%. The incidence according to the duration of PD was 0.3% for PD < 3 years, 0.6% for PD = 5 years, 2.3% for PD = 8 years, and 1.2% for PD > 8 years. In terms of therapy, 11 patients were treated with prednisolone (PSL), and surgical enterolysis was utilized in two cases. Complete remission of abdominal symptoms was achieved in twelve patients (85.7%), and three died due to EPS (mortality rate of 21.4%). ♦ Conclusions: Use of the multidisciplinary approach described above reduces the risk of the development of EPS according to PD duration. In cases of de novo EPS cases in Japan, this strategy can also attenuate the clinical course of the condition.

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“…The use of PD solutions that are more biocompatible, with a neutral pH and reduced levels of glucose degradation products (GDPs), might lower the systemic inflammatory burden by improving peritoneal membrane morphology (4,5); better preserving cellular host defenses (6), leading to a milder physician-rated severity of peritonitis (7); and better preserving RRF (8).…”

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confidence: 99%

Baseline Serum Interleukin-6 Predicts Cardiovascular Events in Incident Peritoneal Dialysis Patients

et al. 2015

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♦ Background: The utility of local and systemic interleukin 6 (IL-6) as a prognostic marker in incident peritoneal dialysis (PD) patients remains to be fully defined. The present study aimed to explore the capacity of systemic IL-6 concentrations to predict cardiovascular events (CVEs) and mortality in PD patients, and to evaluate the influence of neutral-pH PD solutions low in glucose degradation products (GDPs) on systemic IL-6. ♦ Methods: The study included 175 incident participants from the balANZ trial with at least one stored serum sample. A composite CVE score was used as the primary clinical outcome measure. Multilevel linear regression and Poisson regression models were fitted to describe, respectively, the trend of serum IL-6 over time and its ability to predict composite CVE. ♦ Results: A significant increase in serum IL-6 from baseline to 24 months was observed in the study population (mean difference: 1.68 pg/mL; p = 0.006). The type of PD solution received by patients exerted no significant effect on serum IL-6 (p = 0.12). Composite CVE was significantly and independently associated with baseline serum IL-6 (incidence rate ratio per picogram per milliliter: 1.06; 95% confidence interval: 1.02 to 1.10; p = 0.003). ♦ Conclusions: Baseline serum IL-6 was a significant independent predictor of composite CVE. Serum IL-6 concentrations increased with increasing PD duration and were not significantly modified with the use of biocompatible fluid over the study period. The present study is the first to link systemic IL-6 concentrations with CVE outcomes in incident PD patients.

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Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

Cited by 49 publications

References 39 publications

Higher Dialysate Matrix Metalloproteinase-2 Levels are Associated with Peritoneal Membrane Dysfunction

Higher Dialysate Matrix Metalloproteinase-2 Levels are Associated with Peritoneal Membrane Dysfunction

Encapsulating Peritoneal Sclerosis in the Era of a Multi-Disciplinary Approach Based on Biocompatible Solutions: The Next-Pd Study

Baseline Serum Interleukin-6 Predicts Cardiovascular Events in Incident Peritoneal Dialysis Patients

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